Epley Maneuver

An easy-to-perform treatment in which dislodged otolith crystals in the inner-ear canal are guided back to their correct position to relieve sudden, brief vertigo triggered by certain head movements.

Indication

• Brief vertigo triggered by lying down, rolling over, or tilting the head upward
• Diagnosis of posterior semicircular canal BPPV on clinical examination (positive Dix-Hallpike test)
• Recurrent positional vertigo episodes that limit daily life
• Nausea and imbalance caused by displacement of inner-ear crystals
• Posterior-canal BPPV cases that respond inadequately to medication

Preparation

• Detailed history of vertigo and identification of triggering movements
• Determining the affected ear and canal level using the Dix-Hallpike test
• Informing the patient that brief vertigo may occur during the procedure
• Asking about a history of neck, spine, or vascular disease (to allow modification of the maneuver)
• Preparing the patient to lie down comfortably on the examination table

How it's performed

1. While the patient is sitting, the head is turned 45 degrees toward the affected ear
2. The patient is laid back quickly with the head extending slightly over the edge of the table
3. This position is held for about 30-60 seconds, until the vertigo subsides
4. The head is rotated 90 degrees toward the opposite ear and held in this position for the same duration
5. The patient is rolled onto their side and the head is turned a further 45 degrees in the same direction
6. Finally, the patient is brought slowly back to a sitting position; the maneuver is repeated if needed

Post-procedure

• Resting in a seated position for 10-15 minutes after the procedure
• Avoiding sudden head movements and rolling in bed for the first 24-48 hours
• Sleeping in a semi-upright position the first night may be recommended
• If symptoms persist, follow-up within one week and repetition of the maneuver
• Further evaluation of the inner ear and balance system in recurrent episodes

Risks

• Brief, intense vertigo and nausea during the procedure
• Neck or back pain (especially in patients with disc disease)
• A sense of imbalance for 24-48 hours after the maneuver
• Migration of the crystals to another canal (canal switch)
• Need for additional sessions due to recurrent BPPV episodes

FAQ

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